Organization
ST. MARY'S NEUROLOGY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REENA J. KAVILAVEETTIL M.D. (PRESIDENT)
(813) 972-5414
Entity
Organization
Contact information
Practice address
15267 AMBERLY DR, TAMPA, FL 33647-2155
(813) 972-5414
(813) 972-5413
Mailing address
15267 AMBERLY DR, TAMPA, FL 33647-2155
(813) 972-5414
(813) 972-5413
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME92765
FL
Other
Enumeration date
10/10/2006
Last updated
07/02/2015
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